Data clean-up on COVID-19 death

The Central government's affidavit before the Supreme Court on certifying COVID-19 death will require the states to undertake data clean up on COVID-19 fatalities. The affidavit filed by the Ministry of Home Affairs states that the Central government will direct the states that all deaths after a diagnosis of COVID-19 infection, irrespective of comorbidities, are to be classified as "deaths due to COVID-19." The MHA affidavit clarifies that the only exception could be where there is a clear alternative cause of death that cannot be attributed to COVID-19, e.g., accidental trauma, poisoning, acute myocardial infarction etc., where COVID is an accidental finding. The Central government has told the Supreme Court that everyone responsible including the certifying doctor will be responsible for penal consequences for any failure to correctly certifying any death resulting from COVID-19 infection. The affidavit was in response to a directive by the apex court to bring on record the policy or guidelines about death certificates issued to COVID-19 patients, including guidelines by the Indian Council of Medical Research (ICMR). The affidavit was in response to a petition that sought direction by the Supreme Court to the Central government to provide ex gratia of Rs 4 lakh to the family members of those who died due to COVID-19. The Supreme Court reserved its judgment in the case after the Central government told the apex court that the ex gratia cannot be paid as it will put a huge financial burden on resources that are already stretched. As of Monday, data published on the official website of the Ministry of Health and Family Welfare puts the figure of COVID-19 death at 3,88,135. This figure, however, does not include the death of COVID positive patients for other reasons. The daily COVID-19 media bulletin issued by the Health and Family Welfare Department; Assam includes a separate column of "COVID positive patient dead for other reasons." The death toll of 1347 in this column has not been updated in the current second wave which leaves room for confusion over the actual tally of death of patients who tested positive for COVID-19 infection in the state. Given the MHA affidavit before the Supreme Court, the State government is expected to clarify on COVID-19 death certification and if data cleaning up is needed to rectify any deficiencies in death reporting or any lapses by certified doctors. The petitioners sought ex gratia to family members of those succumbing due to COVID on the ground that COVID-19 was declared a "notified disaster under the Disaster Management Act, 2005 through a Central government notification issued on March 14, 2020. Section 12 (iii) of the Disaster Management Act provides ex gratia monetary compensation for the families of those who have lost their lives during a notified disaster. An earlier MHA notification issued on April 8, 2015, fixed ex gratia of Rs. 4 lakh for every deceased person including those involved in relief operations or associated in the preparedness of activities, subject to certification regarding the cause of death from appropriate authority. In an earlier order on a Suo Motu Writ Petition on "distribution of essential supplies and services during a pandemic" the Supreme Court suggested that in light of the human suffering and loss of livelihood that has accompanied this pandemic, National Disaster Management Authority may consider laying down minimum standards of relief in this regard. The apex court, however, clarified that it was not a direction and a suggestion that can be looked into by the NDMA. Accuracy in death certification of COVID-19 patients has been emphasized by the National Centre for Disease Informatics and Research and ICMR in the "Guidance for the appropriate recording of COVID-19 related deaths in India". The guideline states that robust cause of death information in a population is useful for understanding disease burden estimations and explains trends in the health of populations. "It is useful for evaluation and planning of health services and programmes. Good cause of mortality statistics also aids in identifying research questions of public health significance," it explains the rationale behind having authentic data on COVID-19 mortality. The Supreme Court judgment will settle the legal question of whether the next of kin of those who died due to COVID-19 infection are entitled to get ex gratia as sought by the petitioner. However, ensuring that uniform procedure is followed in death certification by all states and all certifying doctors is important for getting authentic and reliable death on COVID-19 mortality. Any underreporting of COVID-19 death on account of procedural lapses will pose a hurdle before health experts in their research work that are critical to evolving the right strategies to contain the spread of the virus and overall global strategy in the fight against the COVID-19 virus infection. The states undertaking Suo moto review of the death certificates already issued will help clean up the data on COVID-19 death to make it more transparent.